States seek transparency on health care sharing ministries

In the most recent blow for health care sharing ministries, Colorado lawmakers passed a bill last month which would require HCSMs to file annual reports with the state detailing financial information about their plans. The bill would require transparency regarding, among other things, how much HCSMs take in through premiums and how much they pay out for claims, according to Colorado Politics. The legislation was sent to the governor’s office in early June, where it now awaits signing.

Health care sharing ministries, or HCSMs, are a form of non-traditional health coverage in which members contribute monthly dues, which are then used to cover health care costs for themselves and other members. Unlike health insurers, HCSMs are not regulated by the Affordable Care Act, and HCSMs have the authority to dismiss claims for a number of reasons, including for religious or moral principles or because of preexisting conditions. Promoted as a cheaper alternative to ACA-compliant health insurance plans, health insurance ministries have seen a surge in popularity since the COVID-19 pandemic left many people unemployed and without benefits.

The exact number of individuals involved in Colorado HCSMs is unknown: “We are not sure how many people are in these plans, we don’t know how many operators there are in the state,” said Senator Christ Hansen, D-Denver, a sponsor of the bill, according to Colorado Politics. “That is precisely what we’re trying to solve.” The bill gives Colorado insurance regulators the ability to fine HCSMs for not complying with the new regulations, or even order them to shut down.

Other states have also cracked down on health insurance ministries in recent years. In Georgia, a class-action lawsuit against one HCSM, Aliera, led a federal judge to rule that it was actually an insurance plan – and was thus subject to ACA rules and other insurance regulations. The judge pointed out that there is no requirement of shared faith among Aliera members and that there are mandatory monthly payments for the plan, both of which indicate the plan should not be considered a HCSM. The lawsuit now moves forward, with the potential to impact around 100,000 Aliera participants.

Similarly, in Washington, regulators have accused high-profile HCSMs Trinity and Aliera of lacking transparency about their plans. According to complaints to state regulators, many plan users were unaware that there was a shared Christian faith requirement for their plans, and some even thought they were using traditional insurance, which would ensure coverage for pre-existing conditions. But Aliera has denied that any of their operations in Washington violated regulations, and argued that their services are an affordable alternative to traditional health insurance for many members.